Clinical Innovation

Modification of Transpalatal Arch for Expansion

Abraham Thomas1, Tawqueer Afshan2, Tenzin Deru3

1
Prof., PG Resident
2,3
Arch constriction is primarily corrected with either slow or rapid maxillary

Abstract
Department of
1,2,3 expansion procedures based on the nature of expansion desired. Clinical studies
Orthodontics, Bangalore have suggested that slow expansion maintains sutural integrity during expansion,
Institute of Dental Sciences, producing a more stable result than rapid maxillary expansion. Transpalatal
Bengaluru, Karnataka, India arch (TPA) is a commonly used appliance for anchorage in maxillary arch and
for controlling the position of molars. In this present article, we have described a
simple modification of the commonly used TPA that can also function as a slow
maxillary expansion appliance.
Received: 02‑06‑2016
Accepted: 30‑09‑2016 Keywords: Orthodontics, slow expansion, transpalatal arch

Introduction

S low maxillary expansion has been a part of orthodontic

treatment modality for many decades now, and a
clinician’s choice of expander depends on his or her
initial diagnosis and treatment goals.[1] Slow expansion,
however, offers more biological benefits compared to rapid
maxillary expansion and can promote better postexpansion
stability after an adequate retention period.[2] An ideal
expansion appliance also requires minimal adjustment and
should permit easy adjustment when necessary.
Transpalatal arch (TPA) has been widely used as an
adjunct in clinical orthodontics for correction of molar
rotations, anchorage reinforcement, molar expansion,
molar distalization, and vertical molar control.[3,4] We
have developed a simple and cost‑effective slow dental
expansion appliance by slightly modifying the classic
TPA design.
Fabrication and Activation
On the working maxillary cast, a removable type TPA as
designed by Goshgarian[5] was fabricated using a 0.036”
stainless steel wire. A helix of 3–4 mm diameter was made
roughly in front of the palatal sheath stubs on either sides
and then the wire was extended by adapting it on the palatal
surfaces of premolars and canine teeth. Activations were
done by opening the helix with a bird beak plier [Figure 1].
After the molar bands are cemented, the appliance can
be inserted just like a regular TPA. The patient maybe
recalled in about 4–5 weeks to evaluate the amount of
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Figure 1: Appliance in passive and activated states
expansion achieved. Since the appliance is removable,
it can easily be disengaged from the palatal sheaths
and further activations can be carried out extraorally
if necessary. After the required expansion is achieved,
the appliance can be left intraorally to maintain the
expansion, and orthodontic treatment can be carried out
simultaneously. The extensions can also be cut off and
the appliance can be used as a regular TPA if required
as well.
Case Reports
The following three case reports are shown to highlight
the efficiency of the appliance, wherein the expansion
achieved was in the range of 5–7 mm in the canine
region and 2–3 mm in the premolar region.
Address for correspondence: Dr. Abraham Thomas,
Department of Orthodontics, Bangalore Institute of Dental
Sciences, Bengaluru ‑ 560 027, Karnataka, India.
E‑mail: dr_abrahamthomas@yahoo.co.in
This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non-commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

DOI:
10.4103/0301-5742.216644 How to cite this article: Thomas A, Afshan T, Deru T. Modification of
transpalatal arch for expansion. J Indian Orthod Soc 2017;51:289-90.

© 2017 Journal of Indian Orthodontic Society | Published by Wolters Kluwer - Medknow 289
 Thomas, et al.: TPA for expansion

a b c
Figure 2: Patient number 1 (a) Pretreatment, (b) End of 4 months, (c) Post treatment

a b c
Figure 3: Patient number 2 (a) Pretreatment, (b) End of 4 months, (c) Post treatment

a b c
Figure 4: Patient number 3 (a) Pretreatment, (b) End of 4 months, (c) Post treatment

• Case number 1: Figure 2 Conflicts of interest

• Case number 2: Figure 3 There are no conflicts of interest.
• Case number 3: Figure 4.
References
Conclusion 1. Ciambotti C, Ngan P, Durkee M, Kohli K, Kim H. A comparison
Advantages of the modified TPA include: of dental and dentoalveolar changes between rapid palatal
• Ease of chairside fabrication expansion and nickel‑titanium palatal expansion appliances. Am
J Orthod Dentofacial Orthop 2001;119:11‑20.
• Can be effortlessly removed and reactivated
2. Marzban R, Nanda R. Slow maxillary expansion with nickel
• During the course of expansion, the appliance can titanium. J Clin Orthod 1999;33:431‑41.
function like a TPA and could continue in tandem 3. Wise JB, Magness WB, Powers JM. Maxillary molar vertical
with regular orthodontic work control with the use of transpalatal arches. Am J Orthod
• Can be converted to regular TPA once the desired Dentofacial Orthop 1994;106:403‑8.
expansion is achieved 4. Tsibel G, Kuftinec MM. A bonded transpalatal arch. J Clin
• Economical and patient friendly. Orthod 2004;38:513‑5.
5. McNamara JA, Brudon WL. Orthodontic and Orthopedic
Financial support and sponsorship Treatment in the Mixed Dentition. 2nd ed. Ann Arbor, Michigan:
Nil. Needham Press; 1993. p. 179‑92.

290 Journal of Indian Orthodontic Society  ¦  Volume 51  ¦  Issue 4  ¦  October-December 2017